TOP DOCTORS MAKE A DIFFERENCE

A Message for Employers and Families

Most people would agree that gambling with their health care is a dangerous idea. When it comes to medical care, excellence
and expertise are crucially important. Yet Americans receive top-quality care from their doctors and hospitals only about half
of the time. From inadequate screening during routine checkups to subpar treatment of critical illnesses, inferior care can
have costly and tragic results. Too often, patients simply don't know how to find the best doctor to deliver the best care.

Castle Connolly takes this challenge seriously. Since the company's founding in 1991, our “Top Doctors” guides have been
identifying the nation's best doctors and hospitals in every part of the country and in every medical specialty. Our lists
are based on peer nominations and professional assessments by our physician-led research team – not on hype, advertising,
or third parties that have something to gain by recommending a particular provider. Castle Connolly's Top Doctors are rigorously
selected from among the total population of 700,100 physicians in practice in the United States. Each year we receive over
150,000 nominations from physicians nominating those they believe to be among the best in their regions and throughout the
nation. Our intensive research methodology is designed to identify doctors that will speed patients' healing, minimize pain
and discomfort, shorten recovery periods and enhance and lengthen lives – in other words, achieve the best possible health
outcomes.

As Marty Makarty, M.D. a surgeon at John Hopkins, wrote in his widely acclaimed book Unaccountable; “So how does a patient who
hasn't been to medical school find the best care? The only real way to judge health care quality is to ask health professionals
who work closely with doctors daily.”

Today, such independent assessment of medical care is more important than ever. Anyone can draw up a “best of” list – and many
organizations do. Pharmaceutical companies favor those physicians who are high prescribers of their drugs. To many health insurers
a physician's fees are often a more important factor than quality. Many publications and websites recommend health care providers
who pay to get their names mentioned. But Castle Connolly has no such conflicts of interest. Our sole purpose is to help patients,
their families and their employers find health care providers who deliver superior results.

Some people believe that patient ratings are the best source of information on doctors. Unfortunately, that is a misguided assumption.
Patients may be able to rate a doctor's “bedside manner,” but they know little about the complexity of medical care. In fact, an article
in Forbes magazine pointed out - “The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary),
over-prescribe and over-test, just to “satisfy” patients, who probably aren't qualified to judge their care. And there's a financial cost,
as flawed survey methods and the decisions they induce, produce billions more in waste.”

After a physician's name is submitted by colleagues as part of our nomination process for consideration as a Top Doctor, our physician-led
research team delves into the professional records of top nominated physicians in order to ascertain those that have exceptional training,
experience and are highly regarded by their peers. In addition, disciplinary histories and malpractice actions are also carefully scrutinized.

Top Doctors can have an enormous impact. For patients and their families, the value of receiving first-class medical care is great – it's
measured in quality and even greater length of life. Employers, however, can see the results in their bottom line. Faulty diagnosis and
improper treatment take a toll in productivity and ripple out into higher workplace costs. No company should have to make do for weeks
or months without a key employee or executive, when a Top Doctor may have solved the patient's problem efficiently and simply.

Castle Connolly has extraordinary examples, some dramatic and lifesaving, that demonstrate the point that finding the best doctor or
hospital can make a significant difference in patients' lives. The few that follow clearly demonstrate this point.

Kay was examined by her local physician, who advised her that lumps in her breast were very likely malignant and recommended an
immediate mastectomy. Closer investigation by a Castle Connolly specialist showed that the lumps were in fact benign and Kay avoided
the cost, trauma and pain of a radical mastectomy.

June was a 92 year old woman diagnosed with rectal cancer. A local surgeon recommended an operation that would leave her incontinent
or, he suggested, she would be dead in 3-6 months. Castle Connolly recommended a top doctor in one of the nation's top cancer centers.
After eight chemo sessions and radiation, she is now cancer free!

Jim was scheduled for surgery to amputate his foot. A relative contacted Castle Connolly to check out his doctor. The research team
quickly identified the surgeon as one who had lost his license in one state and was disciplined in another. The surgery was rescheduled
with a different surgeon.

Rose and Liz, both in their 60's and carrying a few extra pounds, needed knee surgery. Rose chose a physician who practiced near her
home, while Liz picked a Castle Connolly Top Doctor. Two years after her operation, Rose still uses a cane much of the time. Six months
following surgery, Liz was back to her old self and feeling terrific. No doubt, a Top Doctor had a major impact on Liz's favorable outcome.

Karl, the manager of a horse farm, suddenly had a problem with one of his eyes. A local ophthalmologist diagnosed glaucoma and told
Karl he needed immediate surgery. Castle Connolly referred him to a Top Doctor, who has been successfully treating Karl with eye drops
ever since.

Expertise and leading-edge technology are especially important in diagnosing and treating cancer, stroke and cardiovascular patients.
Administered by a Top Doctor, sophisticated techniques may keep pancreatic and brain cancer sufferers alive for years, compared with
the few months that conventional chemotherapy normally achieves. Top Doctors often have higher cure rates for prostate and breast cancer,
thanks in part to early detection, but also due to more advanced treatment options.

Patients with cardiac disease can frequently avoid open-heart or multiple-bypass surgery with stents and other less-invasive technologies.
And although many physicians will counsel elderly patients to avoid surgery under any circumstances, a Top Doctor may be able to operate
on people 90 years of age or older and still achieve excellent outcomes. Stroke victims, in the hands of a Top Doctor, can recover to a
degree unheard of just a few years ago. World-class neurosurgeons can deal with bleeding strokes that were formerly inoperable. Early
detection through imaging and swift treatment with drugs can dissolve clots blocking critical blood flow to the brain before permanent
damage is done – and without invasive procedures. Men operated on at hospitals and by surgeons with high volumes of particular procedures,
specifically radical prostatectomy, had a 7.7 percent risk of recurrence of prostate cancer as compared to 10.9 percent for surgeries
done by physicians with lower surgical volumes.

As further evidence of this principle, consider the following statistics, all reported in a recent Newsweek article and based on
professional journal reports.

At one leading specialty hospital, the five year survival rate for Stage IV prostate cancer is 71 percent vs. 38 percent nationally.

At a major academic health center for Stage IV cervical cancer the survival rate is 33 percent vs. 16 percent nationally. For breast
cancer, after a mastectomy, 81 percent of women treated at top centers are still alive after five years compared to 77 percent nationally.

In addition, a recent study in the Journal of the National Cancer Institute found that treatment variation from surgeon to surgeon is
significant and may account for up to 30% of recurrences of the cancer. Also, in late 2011, “The Annals of Surgery” published a study
that demonstrated that patients with an uneventful course of surgery and recovery had a mean cost per case of $27,946.00 versus $159,345.00
for those patients with complications.

A significant study was recently published in the New England Journal of Medicine. It reviewed the actual surgery results of gastric
bypass surgery on 10,343 patients by the same 20 surgeons, between 2006 and 2012.

The differences between the most skilled and least skilled surgeons were remarkable. Comparing the top 25% to the bottom 25%, the
researchers found:

The least-skilled surgeons had nearly triple the rate of complications, 14.5% versus 5.2%.

Although death is a very rare outcome for gastric bypass surgery, patients had a higher risk of dying if their operations were done
by the least-skilled doctors, 0.26% versus 0.05%.

Across the board, the most skilled surgeons had better results.

Atul Gawande, M.D. in his best-selling book Better, recounted the following concerning the expected outcomes of surgery and how the
expectation was a fairly even distribution of outcomes:

“But the evidence indicated otherwise. What you tend to find instead is a bell curve, with a handful of teams showing disturbingly
poor outcomes for their patients, a handful obtaining remarkably good results, and a great undistinguished middle.

After an ordinary hernia operation, for example, the chances a patient will have a recurrent hernia are one in ten with surgeons at
the unhappy end of the spectrum, one in twenty with those in the middle majority, and under one in five hundred with an elite handful.”

The federal agency for Healthcare Research and Quality estimated surgical errors cost $1.5 Billion annually. They found the average
medical liability payout for a “never” event (should never happen) was $133,055. That is a cost patients and employers ultimately bear.
In fact, a recent “New England Journal of Medicine” article reported that 1% of physicians accounted for 32% of said malpractice claims
over the past ten years.

The bottom line: Top Doctors can help patients in ways not generally available in the medical community. But while people intuitively
know this to be true, most lack the resources to make the best choices when they fall ill. Many people rely on referrals from the family
physician, yet even a trusted and competent physician may not be the best source of information. Doctors are busy with their practices,
and their referral contacts are usually limited to their plan network or hospital. Few have time to research who, wherever in the nation,
is really the best for a particular procedure or problem. That often leaves patients who need a top specialist at the mercy of advertising
and hearsay. They may even pick a name at random from their insurer's directory or website, or even respond to advertising.

Knowledgeable employers realize that providing employees and their families with access to the best medical care, as well as avoiding the worst,
impacts a company's bottom line in a positive way. Money saved on the wrong treatment, unnecessary surgery, days lost from work, or the focus on
the illness of a loved one or oneself instead of work, are worth the effort to identify the best doctors. Castle Connolly not only identifies those
among the very best, it identifies the very worst, to assist your employees and their families in avoiding them.

Castle Connolly is committed to helping patients get the care they need and deserve. Our professional staff, with years of experience, has earned
us the trust and respect of the medical and lay communities alike. We are in a unique position to assist individuals and companies in accessing
the best and most efficient healthcare available today. Castle Connolly's extensive database of over 47,000 Top Doctors is a comprehensive,
user-friendly resource that lets consumers find a doctor by name, specialty, and geographic location – or even by special expertise in a
particular disease or procedure. Hospital affiliations and contact information are presented clearly and concisely. The website (where visitors
viewed over 35 million physician profiles last year), also include helpful tools for choosing a Top Doctor, with tips on how to evaluate
a physician's education, experience, and personal suitability.

When it comes to healthcare, cutting corners rarely pays off. Unlike its imitators, Castle Connolly provides thorough and unbiased research
by trained professionals. We believe that choosing a Top Doctor is the most important decision a patient can make and we work tirelessly to
facilitate that decision.